Psychoimmunology as a common pathogenetic pathway in myocardial infarction, depression and cardiac death

Depression is prevalent in about 30% during the first 18 months post myocar dial infarction (MI), Depression increases the risk of developing cardiac d isease, in particular coronary artery disease and cardiac death, It is an i ndependent risk factor for increased post MI cardiac morbidity and mortalit y, comparable with well-known risk factors such as hypercholesterolaemia. B oth coronary artery disease and depressive disorder are highly prevalent an d co-morbid, resulting in poor overall prognosis. Therefore understanding t he relationship of both disorders, as well as the effects of treatment of d epressive and cardiac functioning, is important, not only from the physical health and quality of life perspectives, but also from an economic perspec tive. In this paper we review the evidence indicating a pivotal role of inf lammatory mediators as a common factor in the pathophysiology of MI, depres sion and cardiac mortality. The effects of antidepressant treatment on thes e inflammatory mediators in Mi-related depression are reviewed. Curr Opin P sychiatry 13:661-664. (C) 2000 Lippincott Williams & Wilkins.